Thursday, 1 May 2008

I’ve heard about Physician's Assistants (previously known as "Anaesthetic Practitioners"), but didn’t really know much about them. These are people who aren’t doctors, but have been on a 2-year diploma course to learn how to give general anaesthetics, and thus work as anaesthetists. There aren’t any such people in my hospital, but one of my friends from uni has worked with them before. I asked him how the Physician's Assistants fitted into the grand scheme of things and the conversation we had was illuminating to say the least.

It seems that someone had a bright idea…

“Gather round people, I have a brainwave. I’ve been spending some time in the operating theatres recently and I’ve seen what happens down there. It seems to me that these anaesthetists don’t do very much. They give a couple of injections, put a tube into the mouth and that’s about it. We have to pay them all this money and I reckon it’s money for old rope. I don’t think you need to be a doctor to give a general anaesthetic. I reckon that you could send people on a diploma course for a couple of years and after they finish, they’ll be qualified enough to give a general anaesthetic. As long as the patients are reasonably healthy, then these people could provide the anaesthetic and do away with a couple of expensive doctors.

“So, here’s the proposition. We could set up the theatre lists so that these Physician's Assistants could have only healthy people on their lists. This means that we run two theatre lists simultaneously with two PAs and one expensive doctor! We get twice the work from a single doctor! It’s genius!”

So far, so good.

The trouble is, giving an anaesthetic isn’t really that simple. In order to give a safe anaesthetic, you need to know a lot of stuff. You can’t train just anyone to do it, especially in only two years. You need clever people.

Now, in my friend’s hospital, unlike the junior doctor anaesthetists, the Physician's Assistants don’t work evenings, nights or weekends, they only anaesthetise healthy (ASA I and II) patients, they do not anaesthetise anyone with moderate medical problems, they do not anaesthetise children, they do not do epidural, spinal or any other regional anaesthesia, they do not cover emergency surgery, they do not cover trauma theatres, they do not cover A&E, ITU, maternity or the delivery suite and they are not part of the crash team.

In short, they are not employed as “replacement junior doctors” (who would otherwise be working on the healthy patient lists), but they are being employed as “Consultant-Lites”

Let’s look at the simple maths of the comparative salaries for two surgical lists run by the two systems

Consultant Doctor + Consultant Doctor

£90 000 + £ 90 000 = £180 000

Physician's Assistant + Physician's Assistant + Consultant Doctor

£40 000 + £40 000 + £90 000 = £170 000

When you factor in the additional pension contributions involved in employing an extra person, the cost to the NHS is pretty much the same.

So, the big question is, what was the point of training these people if it’s going to work out to be just as expensive as before and when a consultant Anaesthetist can do so much MORE than a Physician's Assistant?

My friend spoke about it to one of the Physician's Assistant Trainees and it was telling that the PA said something like, “from a personal point of view, the (diploma) course is fantastic for me. I really like it, it’ll look great on my CV and if I get a job at the end of it, then I’ll get paid well. Looking at the wider picture though, I’m not sure I see the point of it. Don’t get me wrong, I’m not complaining but it seems to me that things would run just as well without us.”

76 comments:

This kind of development is going on everywhere with Physicians assistants in General Practice (playing at Being Doctors) Nurse Practitioners (Assuming the roles of Doctors) etc etc. It is a dumbing down process promoted by Governments.If you want to do the work of a doctor it's easy: 3 'A'a at A-level, 5 Years at Medical School then at least 7 more years in training.

im in my final year at medical school (am in the joyous process of finals at the mo). It really really gets my goat (as a mild understatment). In the 5 since i started medical school i have watched the rise of the noctor - people who are being paid at significantly higher rates than junior doctors - with more exposure to patient care, inflated job titles, preferential treatment and very little accountability.

i will start my job in august (results willing) being a form filling machine whilst people take over roles that doctors have alsways done. Im sure the thrombolysis nurse is very good at what she does but if her patient is really unwell or she isnt sure she will ask some poor sod of a junior doctor who has only seen one guy with a heart attack cos all the rest were done by the nurse specialist. if it all goes tits up who will get dragged across the coals?

i have met noctors who have been on the prescribing course and who are now able to prescibe anything on the formulary. i have done five years at medical school and the thought of prescribing scares the shit out of me.

i am all for people trying to imporve patient care but the way to do it isnt to make nurses into super specialist all singing all dancing nurse consultant specialists. no. its too allow nurses to nurse. in the news over the last few days there have been masses of things about nurses feeling patient care is suffering as they spend too much time doing no essential paperwork.

i appologise that this is a bit of a rant and i appologise if people are offended by its rantiness against nurses. i think nurses do an awesome job under really difficult circumstances, its just that i feel that the medical proffessio as a whole is being gradually eroded and that at some point something is going to snap and patients will die.

it particularly peeves me that the same is happening in anaesthetics as i work bloody hard and that is what i'd like to be when i grow up so dont really want to have to fight tooth and nail for training.

I'm starting my job this year as an F1. I'll be getting something like 20,000 a year, if anything goes wrong, my GMC registration may be in trouble. I wonder why I went through the 5 years (which was really not easy) to get to this life.

Kelly – you’re absolutely right and I’ve edited the post. My GCSE English teacher would kill me if she read this!

Jobbing Doctor – There is more and more of this going on. We asked for an OGD on ITU the other day and the consultant turned up with his “Endoscopy Nurse Specialist” and she did the scope. Where was the Gastroenterology junior doctor? On the ward trying to organise discharges and being hassled by the Bed Capacity Manager, that’s where.

Rob –Regarding “Non-medical practitioners” in general, I can only talk from my personal experience and they’ve seemed to me to be bright, driven, hard-working people.

However, whilst previously, Specialist Nurses worked alongside doctors to help the patients (Palliative Care is an example of a field where this works particularly well IMO) it seems, increasingly they are being employed to REPLACE doctors, and I don’t see the point of this.

The argument has always been that the non-doctors are the cheaper option, but we’re finding more and more that this isn’t the case (mainly because, as mentioned, you have to pay the practitioners lots because they’re clever and wouldn’t so the job for less – they’d so something else) so I’m starting to come round to the view that the powers-that-be just have it in for doctors in general.

Good luck with your finals, I’ll keep my fingers crossed for you

Anonymous 2 – Being a doctor is often shit (especially as an F1) but it’s often fantastic too. I think if you find your groove and you area of interest, then the good times make it all worth it. I wouldn’t worry too much about the GMC. If you’re good enough to pass medical finals, you’re good enough to be an F1, even if you don’t feel that way.

Well, the way I see it, it's just not worth being a doctor these days anymore. To go through 5 years of med school(and this is 5 years of hard work. Not to put down other courses, but hardly any other undergrad course requires the kind of workload that this course does. Even in my 1st year, 5hour lecture days were not rare, while my friends in other courses had something like 5 hours of lectures a week in their 1st year) and come out to find that I could've taken a 3 year diploma course and get paid twice as much!!!

And there is just so little appreciation for the kind of responsibility and stresses you take on as a doctor. This is a job where you literally have to watch every step you make, and just letting your guard down could result in a mistake that can leave you never able to work as a doctor again, not to mention a big blight on your conscience. A large proportion of the public seems to dislike doctors, the government finds it perfectly reasonable to treat us as disposable.

I admire people who still find this a fulfilling career despite everything. But as for myself, I think I've made a huge mistake.

Just wanted to say that PAs have to have an undergrad degree (BSc Hons) in life or health sciences before doing two additional years obtaining the PGDip and then can anticipate at least one or two years internship at the end of that.

PAs are qualified as generalists, although they may undertake additional training to specialise they have to requalify every 5-7 years as a generalist.

In reply to Jobbing Doctor:I am a current trainee PA (A), I have 9 A/A* GCSEs, 3 A’s at A-levels. Unfortunately at the age of 18 I had no clue what I wanted to do for a career, so I went on an achieved a first-class honours science degree and have various other qualifications that I did in my spare time. Unfortunately once I decided what I wanted to do I did not fancy getting myself further into dept by going back and doing a medical degree. This has been a great opportunity for me to do something challenging that I really enjoy and I resent being told that I am part of the ‘dumbing down’ of the NHS just because MD are not amongst the many letters that I have after my name! There seems to be a lot of misunderstanding about the role and if people actually took the time to educate themselves on the role rather than listen to rumours and hear-say they might understand how we ‘noctors’ can have an important role to play. I am speaking on behalf of the science graduates that are doing this role but there are also many ODPs/nurses/Sisters on the course too and the experience they have achieved in their careers is obviously not something that a final year medical student will understand!

Perhaps in the UK Physicians Assistants are different than in the United States, but in the US physician assistants are a vital and valued part of the health care system. Physician assistants work in all health care settings, and are becoming increasingly more vital as Baby Boomers continue to age, leaving the health care system stressed. So yes, you can say that the health care system is being 'dumbed-down' without being able to spell the word assistant, but don't blame them when one of your relatives waits in the ER for hours because of lack of professional care availability.

Well said. I think you should get your facts straight. Maybe have a look at the several reputable universities running the new PA courses in this country at present. No offence, but as a UK PA student I would like to point out that the people on these courses at present have 1st class degrees, have already worked many years in the healthcare profession, and to be quite honest shame the 3rd year medical students on the wards within their 1st year in regards to knowledge and insight. These people do not want to be doctors and hence why they have not chosen to do medicine. Spend more time on understanding the role than wasting energy commenting about something you obviously do not understand.

Hmm...I don't think you have any argument to say that you have more knowledge or experience than 3rd year medical students as they are still at a junior level in their training and are accepted to have not developed the knowledge required of a doctor yet. Perhaps FY1/FY2/ST1 docs would make a better comparison since you are filling a role that was essentially a doctors role.

I am a little concerned with the impact the new PA system has on both FY and medical student training. Had a friend recently do a SSM in Anaesthetics and it was honestly the most useless 4 weeks of her life. When any practical procedures e.g. cannulation, LMA's, intubation etc. were needing done, she was cast aside in favour of PA students/ambulance technicians. This is not the students faults but it happened on such a regular basis that I fail to see how this new role cannot have adverse consequences for anaesthetic training. Hopefully, I will be proven wrong in the future.

I have to say, I think you're a real jackass. You and many of the people who've commented on this blog. In my opinion, you're a bunch of know-nothing's (currently) who just can't stand to see someone with less schooling perform as well, if not better in some cases, than you ever could.

I have personal experience with PAs - being the dumb EMT-P that I am.

I remember a gunshot victim: upper-left quadrant. Totally unresponsive, 'cept for a few bleeps on the monitor. An ambulance didn't bring the girl in (her friends did), so she wasn't intubated yet. I ran in the room to see what help I could give, and I was needed, apparently, because I took over compressions while nurses were busy getting a line in her and the doctor was busy setting up his tube-kit. Finally, the doctor had it all set up and went about tubing her. After several failed attempts, he let the PA take a shot at it. And guess what? He got it in on the first try.

Ain't that something? A dumb PA.

Bottom line: PAs go through essentially the same training as doctors. The only real difference is the residency program. It is my opinion that PAs know as much as doctors, but the title[s] of M.D. or D.O. saves them from being pompous asses, in most cases.

I think it is very arrogant of you to assume that people who choose to enter a medical field and not become a doctor must be less clever than you. The PA profession appeals to many (clever) people because the formalized training is much shorter. I studied at Oxford (my degree was a 2.1) and both of my parents are doctors. I want to be a PA because I want to start a family in the next few years and work part-time after that, and frankly, moving all over the country with limited control over my schedule does not appeal to me. I know many others who feel the same.

As for PAs apparently not being good enough to do their jobs (according to you) please remember that although the training course is very short, the main difference between PAs and doctors is not the length of training, but the formality of training.

Please keep in mind that PAs work closely with consultant-level doctors and over a very long period of time (decades) and learn a lot about that area of medicine to the degree that they can and do preform many tasks that were once solely preformed by doctors.

Doctors are not stupid--and PAs work with the very best of them in the USA. PAs in the US teach medical students and junior doctors. Do you really think that so many intelligent doctors would take ultimate legal and ethical responsibility for care undertaken by the PAs that they hire if they didn't truly believe that the PAs were capable of doing it?

I hope that you don't share some of these opinions with the people you'll work with in the future--my feeling is that you'll isolate nearly everyone who doesn't go by the title "Dr." Be careful with that.

The short answer to that question is yes, PAs can and do get sued. PAs (like any health professional) are responsible for the work that they do, and any negligence on their parts (including doing procedures they're not trained for, etc.). The difference is that the hiring doctor maintains ultimate responsibility for the patient AND responsibility for supervising the PA, so in theory he/she could be sued too. The legal relationship is similar to that between junior doctors and consultants/GPs they train with.

It's worth noting that in an exit survey ( http://www.nes.scot.nhs.uk/documents/publications/classa/UHI_Final_Report_January09.pdf ) following a study on 15 US-trained PAs working in Scotland over 24 months, there were only 2 instances of "minor patient safety issues"--one involved a mixup with patient notes and the other involved a PA advising a patient to change their drug regimen without consulting the supervising GP. It was also found that the doctors generally liked working with PAs and that patients were generally very satisfied with care received from PAs.

Whilst I have the greatest respect for anyone who can complete a medical degree AND survive in the stresses of a hospital environment.The simple fact is that in many other countries in the world non medical anaesthetists are highly trained and respected by medical anaesthetists, and work alongside and complement each other.This is not the case in the UK as so many Doctors are so f**king far up their own arses they cant see daylight( Hey its an english class "caste" thing) Why cant you focus on being the best medical practitioner you can and not on others whom you feel should earn less money/respect whatever. Arent you secure enough in yourself to focus on improving yourself rather than criticise others.These professions have been created due to workforce requirements to meet the needs of a modern healthcare system and due to the WTD provide adequate rest for junior doctors so they are alert enough to be safe (without the use of drugs).Anyway,what I was going to say was the education system is so Dumbed down that there are abssolute idiots becoming doctors, albeit doing ther seven years whatever, (hey its really not the hardest degree anymore), so actually judge individuals on their academic and intellectual merit and dont be such wanker (i.e. predujiced) generalists.I personally have met more than one "stupid" consultant as well as a few brilliant ones.At the end of the day, PAs are supported independent practitioners but look at the title, it says what thet are, not to denigrate but they are a highly educated healthcare practitioner not a doctor, and dont claim to be.OR ALTERNATIVELY ENTITLED F**KING GROW UP AND BE A DOCTOR AND ALL THT REPRESENTS

To the rather angry 'Anonymous' above.Firstly, the term is spelt prejudice, and the use of offense and ad hominem remark will do you no credit. Furthermore, Medicine today is not only amongst the hardest course to complete, but is systematically becoming more and more competitive to enter into. I speak as a student soon to apply to Medical Schools. It is not the case that there is a 'caste'-based system, and all stand an equal chance based on academic merit and motivation. No-one takes this lightly, and you would be foolish to do so. Please do not for a second claim that you have met 'stupid consultants'. Whilst these people may not be able to tie their laces or make a good cup of tea, no doubt they can speak comprehensively on the chromosomal patterns underlying Ehlers-Danlos syndrome. This, by my measure at least, makes them good doctors. What the article you are talking about aims to put across is that these people are not doctors, they do not have anywhere near the education or possibly even the inclination to be named as such. They are, fundamentally, assistants to the physician. Please do not feel that I mean that they should not be treated with the same level of respect entitled to anybody fulfilling such a demanding role, this is not the case, however, they cannot be viewed as medical equals in their professional capacity. If anything, the role seems to be rather unneccessary and potentially wasteful or dangerous.

I'd just like to point out that I am a qualified PA(A); don't start throwing the tomatoes just yet!

There really has been alot of anger and ranting on this thread (something, I unfortunately have become quite used to). I admit, I don't have the same knowledge as a doctor, even though my knowledge is quite extensive. I did an undergraduate degree in Biomedical Science and completed the 2 year post grad diploma in order to obtain the post I currently hold. It was no easy task coming up against all the controversy. I can understand why alot of people have been very wary of this role but I do NOT see myself as a replacement doctor. Anyone who has ever worked with one of us will understand that. I see myself as someone who can help increase theatre turnover time with my specialised training. In my hospital, alot of people who were "anti PA(A)" can now see how useful we are and will barely do a list without us. Also, we DO work weekends. The hospital I am employed with run fracture lists every weekend and there are no trainees present then. Generally, one case will be finishing up and the consultant will be taking the patient to recovery, meanwhile, I will be drawing up drugs,putting iv in, preoxygenating, generally speeding the whole process up. We always manage to squeeze extra patients onto the list as a result. Even the orthopaedic surgeons have commented on how useful this is. I'm sorry so many people have such a bad impression of us, but I innocently applied for this job thinking I could be good at it (which I am) and thinking I could bring something to the table (which I have). Also, we work very effectively with the trainees in our trust. We certainly don't detract from their training. If anything, it means the consultant has more time to focus on them as PA(A)s can carry on with the more mundane tasks whilst they have uninterrupted teaching and training.

Hi to everyone. I am currently training as a PA(Anaesthetics). All of you have posted some nice and good posts. It is an individual choices and some times different people have different opportunities in their lives. Additionally, it is not a matter of cleverness and un-cleverness. Furthermore, its opportunities and luck. PA are always working with consultants. Sometimes, my cosnsultants are less academic than me. However, they are my consultants. Personally, I have 9 GCSC (All A and B grades), 8 A leverls, A and B grades. Then, Diploma in Nursing, followed by DVM (Doctor of veterinary Medicine) and MPH (Master in Public Health medicine). Nonetheless, now I am training as a PA.

Previous poster:Give up the badge collecting and get a life!Nurse, Vet, MPH (you can become a Consultant in that now, don't you know)and now PA(A) - what a waste of the public purse.What you going on to next - medicolegal LLD?

Goodness big debate.. I'm slightly concerned as I was intending on applying to St Georges (UK) this year for the PA Masters.. from my own perspective, yes it would be a great interesting job, good money and all that.. however, I wouldn't feel right about doing it if in fact it is a pointless role if for example, Nurse Practioners basically do the same job.. I want to be of use and really be able to help in the health care system.. otherwise it's meaningless. Can all you health care experienced peeps help me out and explain if there really is a point to PA's, and if there are some vital differences between them and NP's ??? (and i'm not talking about the education, i'm talking about after graduation, the actual work and care they provide)... it would be much appreciated as I will stop wasting my time on applications! :) please honest, not biased feedback

Yes, there is a point to them.There are not enough doctors to go round.New qualifieds flock off to the southern hemisphere and the non-EU doctors that were once the backbone of english on-call rotas aren't allowed in

Pa's can give flexibility to a department but don't provide the answer to all shortfalls, esp on calls.

They are not doctors and are not a substitute for doctors.Ther work along side them and sometimes train them.

It's a great course and a fasinating career but just bear in mond there are qualified PA's without a job, don't beleive the hype.Places on courses are drying up and the number of universitys offering the course this October (2011) are dwinddling.

Hi there, I'm an intensive care nurse with 4 years experience and training in critical care nursing. What I find so difficult with a lot of young doctors today is that they see themselves have the "leader" in a healthcare environment and not part of a team. Ive worked with a lot of extremely experienced consultants, nurses, physios and actually a PA A, who comes to our unit to insert PICC lines. The thing is about looking after a patient is that one profession cant work without the other an we all have our on skills. Ive seen several junior doctors who come to intensive care thinking they are god gift to actually find out they know very little about critical care, panic in emergency situations and often are guided by us on what to do. So please open you mind to what healthcare and medicine is all about...

Good call.it should be about team working.Just a shame it seems to be about kudos, point scoring and getting a higher banding.

PA's are not the new order, but could help small departments that struggle to recruit.

PA's dont help themselves when the price themselves in the same bracket as doctors i.e. 8B+.Although same (ex. nurse PA's) can prescribe a PA is not a doctor.They may have sat in "school" for 5 Years or more but IT IS NOT the same as a medica degree.It is shorter and yes, more focused, but yuou are not a doctor, go back to school for another 4 years and yes, maybe you will be.

Well!, aren't you all a precious bunch! having done some years training, you now feel that only you are qualified to practice routines on people. Let me bring to your notice that there are a great deal of clever, intelligent nursing staff out there with buckets full of experience, wisdom, and common sense who are quite capable of doing such a role , yes, with only 2 years of training. (I might point out here that I am a medical librarian, not a nurse, so carry no predjudice to one group or another, who deals with the whole variety of hospital staff) . I often see F1's who are so stupid, that I would not let them administer me with a plaster, and I know that there are some Nurse Practitioners who have seen more and done more than you could ever have experienced in your dreams. Stop all of this bleeting and learn to work together as a great TEAM. Value each team member on their individual merits, and value experience above all.

I am a UK trained Physician assistant currently consulting in General Practice.

I have a 2.1 with hons degree in Radiotherapy and Oncology and spent 2 extended years at medical school training under consultants under the main area's of medicine, as PA's do 2 EXTENDED years training we actually only have approx 20 weeks less training than a fully qualified doctor who trains on the 4 year entry scheme - which I qualify for.

In addition to this, we have a 1 year internship.

In order to pass the course we sit a 200 x2 medical MCQ paper, sit an in house OSCE with 16 work stations managed by doctors and then sit a national exam which again is examined by doctors at each station. We also have to be signed off by a consultant in each specialist area to state we are able to perform to a suitable level, this includes clerking in patients, performing physical exams and suggesting appropriate managements.

The training is tough.

I am not a doctor, I am a proud Physician Assistant who works alongside the doctoring team at my surgery without rotating so all they invest in me they see the fruits of!

I have worked with many junior doctors and your negative attitudes are not universal, as a whole the FY1s etc have been very pleased to have some help and the PAs are happy that FY1s, FY2s are happy to train them.

Junior doctors on the wards are massively overloaded and once those of you that are coming up to qualification enter the hospital, you will take any help that is offered whether it be a friendly PA or an experienced nurse - one needs to remember - not so long ago, nurses were in a very narrow role, imagine if that was still the case today - doctors would need 8 arms and 5 brains!!

Nurses with that level of training are invaluable and I am not sure it is fair to make a comparision, these breed of nurses are many many years in training, often with a substantial amount of experience that not many professionals can compare to.

I didnt become a doctor because I became a Radiographer and at this point felt training to become a doctor was to much of a commitment, PAs are not doctors, they are not substitutes for doctors.

As a healthcare assistant is to a nurse, a PA is to a doctor. They are a buddy to the doctor, assisting them with there workload.

They are a permanent member of the team meaning that the consultant does not lose them after 6 months and they are a great source of support to the nursing team when doctors are unobtainable.

I understand there is alot of confusion surrounding PAs but the Royal College of General Practitioners support there integration and have more information on PAs on there website.I am happy to answer questions on how a PA works etc...

PA's are offered a 12 month contract as post qualification they are expected to complete a 12 month internship, I have searched the current jobs advertisements for PA's in the UK and they specifically state that they are looking for an intern.

i know pa who are working in hospital. let me tell u, one of them said they didnt even know why th pa programme started, its not organised. they cannot prescribe , but the pa was grateful for that, as they were working in a busy ward. also all teh schools are closing. uve got graduates who took 2 years studying , doing placements, and then no job. consulatnst even said that teh programmes was simply not thouight of before it made its way to the uk

pa programme has been a total waste. I cannot see the longevity of it. now i am in debt. i also have friends who are unemployed. i would like to sue the stupid people who had this idea. if anybody is thinking of doing this programme , PLEASE DON'T. you will regret it. better off, if you be a healthcare assistant, nurse, or doctor.

The PA programs and scope of practice is the US is MUCH different than that in the UK, at least from what I understand. I just recently finished a 27 month program here in the US, where for 14 months I spent 8 hours a day in the classroom and/or labs and then another 13 months on clinical rotations (just like med students, except we go to school year round instead of having summer and winter vacation time). This was 2.5 years of schooling after completing 4 years of undergraduate study. (I like many of my PA classmates were "pre-med" undergrad students who majors in subjects like biology, kinesiology, bio-chem, health studies, ect). Here in the US, PAs are trained in the primary care medical model are seen as mid-level providers, much like a Nurse Practitioner, who also has 2 or so years of graduated medical training. We work side-by-side with out supervising physician treating patients in pretty much every field of medicine. Starting off, as young PAs, we don't have as much autonomy, but as we become more experienced and as the working relationship between our supervising physicians grow, most PAs end up pretty much working on there own only consulting their supervising physicians when they fell necessary. In most states PAs are allowed to prescribe medications, just as they are able to diagnosis and treat patients. I am not exactly sure what type of training PAs in the UK go through, but I don't think it is as rigorous as here in the US. There are plenty of jobs of PAs here in the US, in fact the profession has won awards in the past few years in titles like "Best Career Outlook," "Top Ten Growing Careers," and "Fasting Growing Career." I also feel that I and the rest of the PAs practicing in the US are very well respected by both patients and doctors, both MDs and DOs, which I don't feel is the case in the UK.

Hi to comment aboveYes the training is just as tough here in the UK.We too are expected to have an undergraduate degree in some form of healthcare with some experience.We then do 2 years INTENSIVE training so also do not get summer breaks etc, we work shifts with the doctors and also do lab and classroom studies.

We then sit exams within the university where we have studies, this consists of a practical exam where we rotate around workstations and see "patients" whilst an examiner marks us, and also a long MCQ paper. IF we pass this exam we are entered for the PA National exam which all the PAs from across the country attend. This is much the same as the uni set exams although marked by the governing body of PAs.

In every rotation we do with the doctors we are marked and have to pass each rotation.

It is a very difficult course to pass.

I work in general practice as a PA and am similar to an advanced nurse practitioner, the combination works very well.

Well well well, we do have a bunch of bitter individuals here don't we?

I am a Physicians Assistant in anaesthesia.I am also a registered nurse.I also went to college when i finished school so all in all thats 2 years for my A levels, 3 years for my nurse training and 2 years for my PA(A) training. Not to mention the 10 years I've been working in the NHS since qualifying as a nurse. To me all this 'time at uni' nonsense means nothing.Surely the thing that matters is how well you can do your job and what you can offer to any medical team you are working for?Who said doctors were God? Who said PA's were a threat to doctors? Who said that unless you go to university for 5+ years you're bound to be thick?PATHETIC!!!!

Come on people, be a little open minded here.Junior doctors are bogged down with countless tasks at the best of times, do you not find it helpful having somebody take the pressure off you so can carry out the tasks you will be doing at the highest of your ability without having to rush and possibly make mistakes?Nobody doubts that doctors work hard to get where they are but this doesn't make them any better than any other health care professional, be it a nurse, care assistant, physio, radiographer etc. We all have very different roles, each one being important in the delivery of quality patient care.We shouldn't be feeling threatened by the other professionals we work with we should all appreciate each others role, accept it and just get on with it!!!

Well said!!! PAs are in their own right - health care professionals and are not cheap doctors just as HCAs are not cheap nurses but valuable never the less. We do a fantastic job and the Drs that have worked with us would, I am sure, agree.

Interesting how the tone of these posts has changed. Now that the opportunistic PAs can't get work, the talk is more of wanting to help with the drudge than work as clinical thinkers. The problem wuth the PA role is that its easier to get into, offered more money and better conditions. Thats OK, but invariably the mission creep set in and these new roles want more money, status, respect. They TAKE it and can do do as they are empowered by politicians with an odd doc bashing agenda. Doctors EARN it. It saddens me that so many folk reallt think they are equivalent to or better than doctors when they are simply not. Wanting to be something is not the same as being it. I wanted to be a doctor. I worked hard and became one. You should try it some time. Of course its a bit easier to weazle your way in through these PA/ Noctor type back doors so you do. Thats human nature, but lets call it what it is.

Hmmmm...it really makes me wonder why arrogant doctors go into their profession. They obviously have no people skills at all and their main ambition isn't to make a difference to services offered by the NHS!! It is becoming quite clear that these doctors are in it for the status and the power they feel it gives them. Well that is just wrong!!! Having an attitude like that is dangerous because it means you've got your head so far up your own backside that you're oblivious to the team which are working around you. If you are blinkered it means you're failing to see the bigger picture and i feel that is detrimental to the patients well being. I work with some fantastic consultants who believe the key to quality patient care is team working and respect for those team members. People with arrogance are usually trying to hide something!!!!

I am currently a HCA and have a BSc in medical science. I have applied to Medicine and understand it is a very competitive and intense training course but also career choice and is not a decision I take lightly. Having worked alongside of FY1s, Registrars and Consultants I wonder whether Medicine is what I originally thought it was and whether it is something I want to go into. I have been exploring other professions, PA(A) being one of them.

PAs seem to be a more established role in the US and don’t think that it would have been brought over to the UK if it wasn’t successful. It seems to be a specialist supportive role rather than an invasion of a doctor’s position.

However, it seems that not many universities in the UK are offering PA(A) courses and I wonder how many job opportunities exist post qualification? Is it a day surgery job or is it also seen in the resuscitation department?

Feline friend: I thought your original post was really well written and wondered why you decided to become a PA(A) after having been a nurse?

I decided to become a PA(A) because my nursing career wasn't offering me anything new or interesting. I am quite ambitious and want to get the most out of my career and this seemed like a great avenue to go down as I already had an interest in anaesthetics from working in theatre and recovery.

There have been lots of PA jobs advertised lately on NHS jobs. I am just trained in anaesthetics but there's General PA's who work all over, A&E, surgery, medicine, trauma etc. It's a great avenue to go down and it's becoming more and more popular. Anaesthetic PA's were only introduced about 8 years ago so I think it would be unreasonable to expect a huge recruitment drive for this role so early on. Our role is more recognised than ever. I was anaesthetising for a trauma list the other day with a orthopaedic consultant I've not worked with before, he spotted my job title on my ID badge and said 'oooooh a physicians assistant, I want one of those on my team'!!!!

I'm a general PA and work in general practice. I lead the nurses in the diabetic clinic, I am just about to start initiating insulin in primary care. I insert and remove contraceptive implants, run the anticoagulant clinic including taking responsibility for bridging, I also see hypertension, heart failure and chair the palliative care meetings. When I'm not doing the above....I am on call with the GPs. On top of this I can read X-rays,CT scans,MRIs due to being a radiographer prior to being a PA. I read ECGs, Spiro and when on the wards could interpret ECHOs.....I cannulate, take blood and interpret all my own results. Did I also mention I can catheterise both male and females. Shock horror I even done chest drains on the ward! How on earth did I manage seeing as I am just a dumb PA??!!!!

We don't need to prescribe. We've just initiated a patient specific directive at our hospital for us anaesthetic PA's to overcome the prescribing issue. It's all going very well I must say and the future for PA's looks very bright indeed.

to the hca, thinking of medicine or pa. please dont do the pa course. all the schools have shut the course except for the one in aberdeen. There arent as many jobs as they said there would be. u will regret it. if u want to do medicine, understand it requires alot of responsibility and hard work. stay away from pa course, thats my only advice

Hi. First thing I would like to point out is that there are actually 2 professions being discussed here with 2 very similar names. names put out to consultation and chosen by government, nothing that any of the PAs can do. there are Physician Assistants who work in medical or surgical settings and are trained in the medical model and there are also Physician Assistants (Anaesthesia), who work in theatres etc. I think there has been a lot of confusion between the 2 roles throughout this thread, leading to several myths and animosity towards the roles. I am a physician assistant, and work in acute medicine. I clerk my own patients, come up with my own differentials, recommend my own treatment plan and present my patients on PTWR. I am working with (and I stress the word WITH, not FOR, not INSTEAD OF) my 11th set of FY doctors, and I help them find their feet when they first get on the unit, keep the take moving while they improve their clerking speed and am the person that they come to for advice when the reg is stuck in ED with a sick patient and the RMO can't get off the phone from primary care referrals. I can't prescribe. I am not a doctor. That does not mean that I do not have a good amount of acute medicine experience and knowledge.Not sure where people studied as medical students, but there has certainly never been a lack of patients to see anywhere that i've worked.

Also - the PA courses have not all shut. 2 of them have doubled in size. There are people who want to be doctors, and being a PA will not satisfy that - these people should become doctors. For others (myself being one of them), being a PA is the right choice. I resent that people say I am "playing at being a doctor". Firstly, I'm not playing. Secondly I am not trying to be a doctor. What I am trying to do is to help to take the pressure from the medical team caused by EWTD, increased population size and hugely increased hospital activity without adding to the competition for more senior jobs (meaning that junior doctors have more chance of getting into the specialties that they want to work in rather than stuck in staff grade posts somewhere else because there are too many SHOs around). I would be interested to know how many of the people that are so negative about PAs have actually spent time with one.

which pa courses have doubled in size?as far as I was aware, there was only one pa programme and that was in aberdeen. I am sure anoymous u do good work as a pa. but i can tell the physician assistant course was a disorganised waste of time, the role was not thought of in more detail. do physicians assistant have portfolios of work they have to fill in like fy1 and fy2. no they dont.and where are the jobs being advertised , cos i have only seen them come up once in a blue moon.

theres quite a few physician assistants who have graduated for over a year who still have not found their first Physician Assistant Job. And so their slowly losing their knowledge. The universities from where they have graduated havent helped them.

The University of BIrmingham are still running the Physicians' Assistant Anaesthesia course and they're continuing to have lots of interest from various trusts.Sheffield are advertising for PAA's at present to add to the team of PAA's they already have. In Dudley we have to keep an an anaesthetic logbook of the cases we do and I also have to keep a portfolio of competences and knowledge just like the CT1 and CT2 anaesthetic juniors have to. In fact, the Royal College of Anaesthetists paper work is what we use for these. I went to the Association of Physicians' Assistants conference a few months ago and the outlook is very bright indeed. Our services continue to grow and our ever growing skills continue to be supported by the Royal College of Anaesthetists. The University of Birmingham is just in the final stages of finishing some bolt on modules so we can branch out into critical care. It's all looking good!!! And yet again I will stress that we are not a threat to doctors we are merely there to lighten the work load and work as part of a team. I hate these arguments about who is the better profession. We all have a valid role in health care. This is just how the NHS is modernising and redeveloping itself. Trust me, I've been working for the NHS for over ten years and so much has changed.

felin friend, I was talking about the physician assistant programme which is different tothe anaesthesia course. the physician assistant course has stopped running cept in aberdeen. and yes tere are still physician assistanst that still havent not got their jobs despite graduating over one year ago. so perhaps for the anaesthetics it looks bright.

St George's train PAs. We have a managed voluntary register and to maintain registration have to meet CPD requirements. I keep a portfolio of what I do and during training you do have a skills work book which has to be signed off before grafuation. There are lots of PA jobs which are advertised through UKAPA our governing body. There are also agencies offering locum jobs for PAs. Us who are employed as PAs are very excited about the future role. Unfortunately as with any course, includingNursing, not everyone is able to find suitable employment straight from university.

hello,first of all I am a physician assistant and like to add my input. when the previous person said they have a skills workbook which has to be signed off before graduation. I can tell you know whilst I was training I never had a skills workbook. whilst i worked as a pa, I never had a portfolio or a list of practical skills that needed signed off.Infact I then had to devise my own little ticksheet and adapt it from the fy1 and fy2 . But this wasn't that good. I didnt graduate from st georges. which agencies are offering locum jobs to pas? Id like to know, cos I heard from my colleagues that its difficult as pa cant prescribe hence no agencies are interested. Also with nursing u can find some temp work easily, once u get your paperwork, registration and up to date training.

I qualified from UH and had a skills workbook that had to be signed off, not only once but had to be signed to say I had watched the skill then I had safely been supervised carrying out the skill. If you were a member of UKAPA you would see there are many jobs being advertised including locums. I work with many nurse practitioners who cannot prescribe but it doesn't mean they are any less of an asset to the team, in fact on calls in large primary care centres would struggle without nurse practitioners or physician assistants.

I take some responsibility for my practices as a member of a health care team, I keep a portfolio and record patient numbers for any surgical procedure I carry out plus any complex practices such as insulin initiation. I also keep anonymised copies of a variety of referral letters I've sent and a comprehensive record of ALL CPD I do. As a PA I make sure I can demonstrate my worth because it is a new role. My mentor looked through EVERY patients I saw for my first 18 months in practice and I have seen approx 35 patients a day for the past 2 years with Absolutely NO complaints from a single patient and absolutely NO issues with my practice, in fact I have had 2 lung cancers come through my on call in this time and have picked up both the first time I met these patients - despite never seeing them before. I am a competent health care professional who takes my job very seriously and practices medicine to the absolute best of my ability, it is ridiculous to think a PA cant add anything to the health care team, I've had at least 3 practices approach me about a job in the past 2 years so PAs who aren't finding employment need to get out there and show the world what they are about

HiI have worked with PA's and intially I was apprehensive about their role and being a new breed workforce. But they have surprised me; In Cardiology there are PA's doing Central Lines and when the juniors are unsure about something they will ask the PA. In A&e they essentially do everything from start to finish with a patient and theres a PA in Birmingham City hospital who will see really unwell patients. Some of them can even do their own Fastscans. I don't think they are out there to take over other people's jobs or roles; they are really friendly people and help their fellow colleagues alot, you can handover patients to them and they will make sure jobs are done etc. Give them a break.

There are PA's in neuro who are trained to do LP's but from what I know the Doctor's training isn't taken away. FY2's/SHO's have their protected teaching time and as far as I know PA's don't get much teaching, yet they are expected to do a fair amount of work.They aren't a threat to anyones profession, if anything they are hardworking people from what I've seen.

I have stumbled across this debate whilst researching, and I have to say that I am astounded at the level of anger! When did being a healthcare professional become all about how many qualifications you have? Surely it is about the best care for patients, that is after all why people are supposed to choose such careers, an inbuilt moral conscience for the greater good. Perhaps I am niave or too idealisitic but after working in an inner London Hospital I can assure you that physician assistants and nurse practitioners do provide a useful service. It is unfortunate that the pressures of targets etc are pushing the NHS to bursting point. Doctors, nurses and physician assistants all have different job specifications and skills, yes some of them overlap, but in general it all works very well to provide the best care to patients in a very difficult and stressful environment. Patients keep on coming in regardless, PAs help. Surely we should all respect each other and appreciate the work each of us do?

p.s to all those angry Doctors who are so irate and viscious towards the PAs and what they do, you should stop being so insecure about your own capabilities and worth. Docotrs are doctors, nurses are nurses and PAs are PAs. If you can't respect and understand your work colleagues and other members of the MDT, then you can't respect and understand your patients.

Practices require medical assistants to look after the front office administration including staff management, appointment scheduling, filing reports, maintaining patient charts, bookkeeping, billing, tax and insurance processes. With the federal government incentivizing Meaningful Use of EMR implementations, a majority of administrative and clinical tasks have been digitized. As the onus of meeting Meaningful Use objectives lies largely with medical assistants, practices have started to consider IT skills as indispensable to medical assistant skill sets and resumes.

Some sort of Health care Helper is really a non-licensed healthcare specialized which generally performs within the oversight of the registered medical professional in the doctor’s place of work, centre, clinic or even some other healthcare placing to aid from the corporation and sleek running on the capability. Schooling is normally the initial step to a career on this sought after discipline, to help offer you several years involving fulfilling function knowledge!

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250 k to train a doctor who may well go to Australia, or take a different career path. However I think the NHS needs to find alternatives to expensive doctors when they are not needed and let them do the difficult stuff. The uk isn't made of money.....

It's this level of prejudice and animosity to anyone in an advanced role that doesn't have the title of "dr" that is leading me to quit my job as a physicians assistant in anaesthesia. After 19 years in the nhs a Bsc and 3 post grad qualifications I really can't be arsed dealing with the sarcastic comments from middle class primadonnas who believe that my mere prescence somehow downgrades their qualifications. I never wanted to be a Dr hence never going to medical school. I did however want a challenging career that enabled me to provide excellent patient care as part of a mdt. Obviously I should have known my place and not bothered applying for the post and completing my training. I am I off to work in academia if that's ok with all you bitter and stressed out medics. Unless of course that too is a job that I shouldn't be doing. Don't forget the salaries of PAs stay around 40k for the whole of their career while yours will rise to over double that with an increased pension and the opportunity to gain silver and gold awards to plump up your pension pot still further. If you still think we have the better deal my job will be free later on in the summer so quit your career pathway and apply. If you can't beat em join em!